Medical aid fraud falls.
The overall number of fraud cases in the medical aid industry has decreased, but among service providers it was increasing, a KPMG KPMG Klynveld Peat Marwick Goerdeler (accounting firm)
KPMG Kaiser Permanente Medical Group
KPMG Keiner Prüft Mehr Genau (German)
KPMG Kommen Prüfen Meckern Gehen survey has found. The Medical Schemes' Anti-Fraud Survey, which covered the three years from 2007 to 2009, showed that the fraud-to-claims ratio had fallen by 0.15%, said national forensic Belonging to courts of justice.
forensic 1) adj. from Latin forensis for "belonging to the forum," ancient Rome's site for public debate, and currently meaning pertaining to the courts. director for healthcare, Camilla Singh. 'We can clearly see the ratio of investigated fraud to claims is dropping. This is an achievement for South Africa's medical aid administrators,' said Singh.
The survey was sent to 15 administrators and the eight respondents In the context of marketing research, a representative sample drawn from a larger population of people from whom information is collected and used to develop or confirm marketing strategy. represented 84% of all principal members. Medical schemes which participated in the survey included Discovery, Medscheme, Metropolitan and Momentum, said Singh. She said the survey showed that the number of fraudulent The description of a willful act commenced with the Specific Intent to deceive or cheat, in order to cause some financial detriment to another and to engender personal financial gain. claims by members was also at a low and amounted to R67.3 million out of a claim value of R145 billion over the 3-year period. The most common reason given for member fraud was non-disclosure of prior ailments. This amounted to about 92% of all cases.
However, service provider fraud was increasing. Code manipulation was the most common type investigated, followed by services not rendered. 'There has been a definite crackdown on fraud in this industry in the last decade: Singh said. In KPMG's 2001 - 2003 survey, only 49% of medical aid administrators said they never kept quiet about fraud cases, said Singh. By 2009 this had risen to 100%.